I have a nearly four-year-old toddler and we are having difficulty with her toilet training. Some days she is perfect and goes to the toilet all day long really well. Other days she wets herself. I have tried everything. We have had her checked for urine infections. She seems to not need to go a lot in the mornings and then lunchtime on she just seems to be constantly wetting herself. She can pee that many times throughout an afternoon it’s scary. The amount of washing is killing us … not to mention the stress of not knowing what else we can do. I watch her and she gets a look on her face but then won’t move. I can ask her if she needs to go to the toilet and she will say no but then pee herself or I have to force her to go to the toilet. I have gotten her to clean herself up and change herself. I have told her off. I have tried to be patient and explain things. I have even taken her to the toilet every half hour. It is beyond a joke. If I put a nappy on her she just pees in the nappy. Please help.

Dr Justin says:

This happens a lot more than you might realise. Research suggests that a small percentage of children aged four to six years have daytime enuresis episodes – and it is more common in girls than boys. That doesn’t make you feel much better when you’re still stuck washing clothes, floors, car seats, carpets, shoes, and everything else – endlessly! But it lets you know that your child isn’t completely unusual in this situation.

A few recommendations

First, is there anything that has been occurring that is particularly significant and that could be creating stress for your little one? Stress and anxiety can lead to a sense that the child has no control over her life. Sometimes kids will try to regain control (or get extra attention from you) by wetting their pants and showing other toilet difficulties.

Second, and perhaps as an extension to the first point, when kids feel lots of pressure, there are times when they feel overwhelmed by it and you lose any possibility of getting the result you want. You might call it a form of performance anxiety.

Third, if a child is feeling stress and anxiety, they will sometimes wish they were a baby again because they know that babies get looked after. So your daughter’s wetting may be a function of this desire.

Either way, I suggest that you:

1. Take the pressure off entirely.

2. Have one casual conversation about toileting. Mention that it’s been a problem, but that you’re not going to get upset anymore.

3. Give fewer reminders about toileting. Your daughter probably knows what is expected, but it’s not translating into behaviour. Reminders won’t be helpful in doing anything except reminding her of her failings.

4. Reassure her that you love her regardless of where she toilets, and you know that eventually she will figure out the whole toilet thing.

5. From now on, treat it fairly casually. Regardless of how angry you are, don’t show it. Instead, just acknowledge it, clean it up, and leave it at that. No lectures. No reminders. No reprimands. And no anger.

Easy does it

I know this seems counter-intuitive. But the more we force things, the harder people push against them. Your other methods haven’t been working, so I suggest you try a more relaxed approach. It will probably take about a week before your daughter starts to relax. I’d suggest that the ‘accidents’ will continue for several weeks, but will eventually just stop.

(Note: I strongly discourage use of reward systems and charts. This is because the promise of reward implies the threat of punishment – your child implicitly knows that to fail to get the stars will feel like a punishment. Also, the reward can cause power struggles in the relationship – going to the toilet will become more about stars or rewards than peeing in the potty. Further, using rewards ignores the reasons this is actually happening! I could go on, but will leave it there to spare you all the other details.)